AUTHOR=Yuan Kexin , Li Runting , Zhao Yahui , Wang Ke , Lin Fa , Lu Junlin , Chen Yu , Ma Li , Han Heze , Yan Debin , Li Ruinan , Yang Jun , He Shihao , Li Zhipeng , Zhang Haibin , Ye Xun , Wang Hao , Li Hongliang , Zhang Linlin , Shi Guangzhi , Zhou Jianxin , Zhao Yang , Zhang Yukun , Li Youxiang , Wang Shuo , Chen Xiaolin , Zhao Yuanli , Hao Qiang 

TITLE=Pre-Operative Predictors for Post-Operative Pneumonia in Aneurysmal Subarachnoid Hemorrhage After Surgical Clipping and Endovascular Coiling: A Single-Center Retrospective Study

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.893516

DOI=10.3389/fneur.2022.893516

ISSN=1664-2295

ABSTRACT=<sec><title>Objective</title><p>Postoperative pneumonia (POP) is one of the major complications after aneurysmal subarachnoid hemorrhage (aSAH) associated with postoperative mortality, prolonged hospitalization, and increased medical cost. Early recognition of pneumonia and more aggressive management may improve patient outcomes.</p></sec><sec><title>Methods</title><p>We retrospectively reviewed all patients with aSAH who were admitted to our institution between January 2015 and December 2020. Baseline clinical characteristics, imaging data, and inflammatory biomarkers were reviewed. The risk factors derived from multivariate logistic regression of surgical clipping (SC) and endovascular coiling (EC) were analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate each independent predictor's prediction ability.</p></sec><sec><title>Results</title><p>A total of 843 patients were enrolled. Compared with patients in the EC group, the incidence of POP was higher in the SC group [143/414 (34.54%) vs. 114/429 (26.57%), <italic>p</italic> = 0.015]. In the EC group, multivariate analysis revealed that age [<italic>p</italic> = 0.001; odds ratio (OR) = 1.04, 95% CI = 1.02–1.07], posterior circulation aneurysms (<italic>p</italic> = 0.021; OR = 2.07, 95% CI = 1.14–3.83), higher neutrophil (NEUT; <italic>p</italic> &lt; 0.001; OR = 1.13, 95% CI = 1.06–1.21), World Federation of Neurosurgical Societies (WFNS) grade 4 or 5 (<italic>p</italic> &lt; 0.001; OR = 4.84, 95% CI = 2.67–8.79), modified Fisher Scale (mFS) grade 3 or 4 (<italic>p</italic> = 0.022; OR = 2.60, 95% CI = 1.15–5.89), and acute hydrocephalus (<italic>p</italic> = 0.048; OR = 1.74, 95% CI = 1.01–3.00) were independent risk factors for POP. In the SC group, multivariate analysis revealed that age (<italic>p</italic> = 0.015; OR = 1.03, 95% CI = 1.01–1.05), WFNS grade 4 or 5 (<italic>p</italic> = 0.037; OR = 1.76, 95% CI = 1.03–3.00), heart disease (<italic>p</italic> &lt; 0.001; OR = 5.02, 95% CI = 2.03–12.45), higher white blood cell (WBC; <italic>p</italic> &lt; 0.001; OR = 1.13, 95% CI = 1.07–1.20), and mFS grade 3 or 4 (<italic>p</italic> = 0.019; OR = 2.34, 95% CI = 1.15–4.77) were independent risk factors for POP.</p></sec><sec><title>Conclusion</title><p>Patients treated with SC are more likely to develop POP. Comprehensive preoperative evaluation of patients may help physicians to better predict POP and implement preventive measures to improve outcomes.</p></sec>